We are in the middle of the 20th annual World Breastfeeding Week (August 1-7)–and though it’s not exactly the Olympics in terms of media coverage, WBW is a very worthy cause for public celebration.

WBW is sponsored by the World Alliance for Breastfeeding Action (WABA). This year’s theme is Understanding the Past – Planning the Future: Celebrating 10 years of WHO/UNICEF’s Global Strategy for Infant and Young Child Feeding, and I’ll be writing a few breastfeeding-centered posts in the next week. In keeping with the “understanding the past” theme, I’d like to lead off with a bit of breastfeeding history.

This is an excerpt from an article I wrote on breastfeeding that never ran in the San Francisco Chronicle a few years back (don’t get me started…). The “public scolding” at the end refers to the personal situation of a mother in my practice. Due to a chronic illness she was unable to produce enough milk to exclusively breastfeed, and found herself being scolded by strangers when she of necessity “topped off” her baby with formula after breastfeeding as much as she could. Her story led me to read up on the cultural history of breastfeeding.

The “breast-versus-bottle” controversy is a relatively recent development in the history of infant feeding. For hundreds of years, the argument centered not on the merits of breastfeeding itself, but rather on whose breast was best suited for the job.

Wet nursing–one woman breastfeeding the infant of another–was common among affluent women from before the founding of the Roman Empire through the end of the French Revolution. But debate surrounded the practice from earliest times, as evidenced by the writings of Soranus of Ephesus, a renowned Greek physician of the second century AD.

Soranus was a staunch proponent of wet nursing. He considered a new mother’s milk “unwholesome, raw, hard to digest… and not prepared to perfection,” and declared that the breast milk from a woman who had already nursed a child of her own for at least two or three months was the healthiest choice for a newborn. Damastes, a physician and rival medical writer, strongly

Soranus: Wrong…

disagreed, asserting that nature intended for a baby to feed at its own mother’s breast. His teachings drew Soranus’ published ire.

“One ought to censure Damastes,” Soranus wrote, “who orders the mother to give the newborn her breast immediately [because] nature has provided for the production of milk beforehand so that the newborn may have food straightaway.” This was “plausible sophistry” to Soranus, who compared a mother nursing her own infant to an exhausted, barren field – she risked “grow[ing] prematurely old, having spent herself through the daily suckling.”

The writings of Soranus influenced infant feeding practices for well over a thousand years. Until the mid-eighteenth century, babies born to women of the aristocratic and merchant classes of Western Europe were customarily “placed out” to wet nurses. The practice was so entrenched that fewer than 1,000 of the estimated 21,000 babies born in Paris in 1780 were nursed by their own mothers. The common wisdom–that nursing spoiled a woman’s figure and made her “old before her time”–echoed Soranus.

The wide acceptance of wet nursing was a catastrophe for Europe’s newborns. Many wet nurses – often poor and malnourished – took on more babies than they could possibly feed, resorting to a thin, germ-ridden ‘pap’ of bread and water to supplement their own overtaxed milk supplies. The death rate among wet-nursed and artificially fed babies, mainly from infectious diarrhea, was staggering–over 90% in some areas.

Breastfeeding surged in popularity in the late 1700s, after physicians established the connection between feeding practices and infant mortality. By the early 1800s, the majority of women of all social classes nursed their own babies, including an estimated 95% of infants in the United States.

But the Industrial Revolution dealt breastfeeding a blow from which it has yet to fully recover. Science equalled progress in nearly all aspects of nineteenth-century life, and infant feeding was no exception. Artificial feeding and commercial formulas became acceptable to women, even necessary for the growing number of female factory workers.

The twentieth century ushered in the age of “scientific mothering”, which dominated Western-style infant care through the 1950s. Babies were raised “by the book”–books that often emphasized cod liver oil and artificial feeding. Independence – toughening up a child for his own good–was the goal. Encouraged by physicians, “medicalized” infant care became the norm.

We know now that the emotional, nutritional and immunological benefits of breastfeeding make nursing the single most important thing a mother can do for her baby. Yet the challenges facing nursing mothers today–smaller, more isolated families, demanding careers and an often unsupportive society–are daunting.

Nearly two millenia after Soranus took Damastes to task for his views on infant feeding, the intense emotions that surround breastfeeding remain largely unchanged. No record of Damastes’ reply has survived to the present, but if contemporary behavior is any indication, he likely cornered Soranus in a local market and gave him the ancient Greek version of a modern public scolding.